Provider Demographics
NPI:1588936959
Name:ROBERT E. WHITE, MD, FACOG
Entity type:Organization
Organization Name:ROBERT E. WHITE, MD, FACOG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ELLISON
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:214-824-3730
Mailing Address - Street 1:3801 GASTON AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1541
Mailing Address - Country:US
Mailing Address - Phone:214-824-3730
Mailing Address - Fax:214-821-5473
Practice Address - Street 1:3801 GASTON AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1541
Practice Address - Country:US
Practice Address - Phone:214-824-3730
Practice Address - Fax:214-821-5473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7501207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098950101Medicaid
D69254Medicare UPIN